James Rodgers RECEIVED
22 2024
City of Miami Beach
1700 Convention Center Drive p F/CE F'11,4.MI BEACH
Miami Beach, Florida 33139 G .•HE CITY CLERK
OFFICE OF THE CITY CLERK
Email:BC( miamibeachfl.gov
Telephone: 305.673.741 1
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check(✓)all that apply):
I am a resident of the City of Miami Beach for six months or longer.
Home Address: fV/7 Gevich'rf✓e7j/7 5" 3 iZ y
have an ownership interest(for a minimum of six months) in a business established in the
City of Miami Beach (for a minimum of six months).
Name of Business: Ui fines '-k att c" 6._--,,
Business Address: /G'ci i14/C4,f4.i Itie ,fir 7/i ,s,�r�'j°
I am a full-time employee of a business (for a minimum of six months)and I am based in an
office or other location of the business that is physically located in Miami Beach (for a
minimum of six months).
Name of Business:
Business Address:
"Ownership Interest" means the ownership of ten percent (10%) or more (including the
ownership of 10%or more of the outstanding capital stock)in a business.
"Business"means any sole proprietorship, sponsorship, corporation, limited liability company,
or other entity or business association.
Under pen ties of perjury, I declare that I have read the foregoing document and that the facts
stated re true.
A...-- a if) /Vol 9
Sig ture Date
Printed Name